Iranian Journal of Public Health
Volume:37 Issue: 4, Winter 2008

Glucose-6-phosphate dehydrogenase (G6PD) Deficiency is the most prevalent enzymopathy in mankind. It has sex-linked in heritance. This enzyme exists in all cells. G6PD deficiency increases the sensitivity of red blood cells to oxidative dam age. G6PD deficiency was discovered in 1950 when some people suffered hemolytic anemia as a result of taking antimalar ial drugs (primaquin). Most people with G6PD deficiency do not have any symptoms, till they are exposed to certain medi cations, Fava beans and infections; and then their red blood cells are hemolyzed. The degree of hemolysis changes accord ing to the degree of enzyme deficiency and the oxidant agent exposure. G6PD deficiency has many different variants and Medi terranean variant is the most common mutation in the world. G6PD deficiency is considered a health problem world wide, especially in Asia, Middle East and Mediterranean countries. In this article, we have reviewed the importance and func tion of G6PD enzyme, incidence rate of G6PD deficiency in the world and Iran, genetic and variants of this enzyme, clini cal manifestation, diagnosis and treatment of the enzyme deficiency.

Parvovirus B19 (B19) is the only member of the family Parvoviridae associated with human infection. Al though there are some studies to estimate the immunity to parvovirus in various populations but there is no seroepidemiologi cal sur vey from Iran until now thus the age-specific immunity to human parvovirus infection was esti mated. A subset sample of 1500 study subjects in 2004 after Measles and Rubella mass campaign was selected from the original samples of 5000 sera kept at the Department of Virology in Tehran University of Medical Sciences. All sera were tested by a commercial ELISA kit. Totally, 1303 (86.6%) of 1500 study subjects were seropositive for B19 IgG antibody. The seropositive rate of males and females were 85.3% and 88%, respectively (P= 0.129). The overall B19 seropositive rates in rural and urban were 84.3% and 88%, respectively (P= 0.044). The seropositive rates were found to increase significantly with age and ranged from 79.3% in 5-9 year old group to 93.5% in 20-25 yr old group (P= 0.000). Our results indicate that in spite of high prevalence of B19 antibody the importance of routine diagnosis of B19 infection in order to elucidate the etiology of some unexplained ''exanthemata diseases’ especially in measles elimina tion and eradication phase is needed.

A crucial part of a case-control study is the selection of a sample of controls that represent the base-popula tion from which cases were drawn. Controls may be matched to cases by one or more potentially important confounding vari ables, such as socioeconomic status. In the United Kingdom, one method for control selection has been based on the pa tient list of the General Practice with whom the cases were registered, which we refer to as GP-matching. We aimed to ex plore whether GP-matching adequately control for the potential confounding effect of socioeconomic status. The Townsend index of deprivation was calculated for different two national census geography levels of Elec toral ward/Postcode Sector and Enumeration District/Output area for the three study areas of Dundee, Leeds and York. Con ditional logistic regression was used to estimate the association of cases with deprivation (based on the Townsend index) com pared with that of matched controls for the two geographical scales. At the largest geographical level (Electoral ward/Postcode Sector) there was no evidence of a difference in the dis tribution of deprivation scores between cases and controls. However, analysis at the smallest level (Enumeration Dis trict/Output area) showed that, despite GP matching, cases were more likely to live in deprived areas than matched controls. Using General Practice lists for the selection of controls for controlling the confounding effect of socioeco nomic status might not be an appropriate method for case-control studies conducted in the United Kingdom.

The indicators for adverse events screening, developed by Wolff in Australia, use ready available data in or der to identify “red flag” cases that might need to be reviewed by clinicians in terms of medical documentation. In this study, the 8 indicators developed by Wolff were used in the process of screening the electronic patient records from the 41 district hospitals in Romania. Data used is the Romanian Minimum Basic Data Set for 2006 collected at the National School of Public Health and Health Services Management, the institution in charge with data collection and processing. From the 8 indicators selected by Wolff, only one could not be used due to lack of data in the Romanian Mini mum Basic Data Set. The distribution of these indicators in the 41 district hospitals shows wide differences among hospitals. This could represent an indication of higher clinical risk at some hospitals, but they can mean as well errors in the collection and man agement of data from the electronic patient records. The study shows that the indicators can be used by hospitals for benchmarking clinical risk, although a better standardization and monitoring of data reporting is necessary in order to increase their validity. The Minimum Basic Data Set represents an accessible instrument for identification and measuring of clinical risk, but for purpose of utilization at na tional level we recommend at first the validation of data used to build the indicators, followed by the testing of the sensibil ity, specificity, and the positive and negative predictive values.

Toxoplasmosis is a zoonotic disease with widespread distribution throughout the world. It is caused by the pro tozoan parasite Toxoplasma gondii. As laboratory diagnosis of toxoplasmosis is not straightforward, this study was aimed to compare the sensitivity and specificity of conventional and unconventional methods of diagnosis based on the meas urement of IgM and IgG for determination of the best method. One hundred suspected cases of toxoplasmosis referred to two laboratories in Tehran and Karaj were entered into this comparative analytical study. The serum specimens of these cases were tested with ELISA, IFA, chemiluminescence (CLIA) and ELFA for presence of IgG and IgM. When compared with the ELFA IgG method, the CLIA IgG had the highest sensitivity, specificity, and positive and negative predictive values (100%). In comparison with ELFA IgM method, CLIA IgM and ELISA IgM had the same sen sitivity (92%), but the sensitivity of ELISA IgM (100%) was higher than CLIA IgM (97.3%). The positive and negative pre dictive values of ELISA IgM were 100% and 97.4%, respectively and those of CLIA IgM were 96% and 98%, in that or der. Although, the reliability of the compared methods are close to each other, the automatic methods (CLIA, ELFA) are preferred because of high reproducibility, less personnel costs, shorter test time and etc. Therefore, we recom mend application of these methods for diagnosing of toxoplasmosis and re-emphasize that these are the most suitable tests for measurement of toxoplasma IgM levels.

Acute fulminant fungal sinusitis is a rapidly progressive disease with high mortality (50-80%) and occurring with increasing frequency in patients with acute leukemia. The purpose of the present study was early diagnosis of this le thal infection. In a cross-sectional study, 142 patients with hematological malignancies were studied immediately by initiation of chemotherapy to determine early clinical and radiological findings of invasive fungal sinusitis. This infection was con firmed by pathological and mycological methods. Acute fulminant fungal sinusitis was diagnosed in 8 patients with acute leukemia. The most common isolated fungi was Aspergillus flavus (n= 5) followed by Aspergillus fumigatus (n= 2) and Rhizopus sp. (n= 1). Despite prompt surgical and medical therapy, the disease in our patients was very aggressive with a rapid clinical course and high mortality. The present report shows the poor prognosis of invasive fungal sinusitis in neutropenic patients; the necessity to take intensive preventive measures and the application of new diagnostic methods for early detection of fungal infection in these high risk patients.

Haemophilus influenzae type b (Hib) has emerged as the predominant cause of meningitis in developing coun tries wherever it has been studied using good microbiologic procedures, but data regarding frequency, antimicrobial sus ceptibility and preferable method for detection of Haemophilus influenzae type b isolated from Iranian patients were scarce. One thousand and eight hundred suspicious CSF samples were received from Children Medical Center Hospital in Tehran, periodically. All samples were cultured on conventional and selective media for Haemophilus influenzae type b de tection. PCR performed for samples were Hib negative in culture. The susceptibility of the isolates to different an timicrobial agents was determined using the disk diffusion method. Overall, 6.7% (n= 121) of specimens had positive culture. 15.7% (n= 19) of isolates were diagnosed as Hae mophilus influenzae type b with both culture and Antiserum test. PCR assay detected 10 isolates of H. influenzae type b in sam ples weren''t detected in culture. H. influenzae type b isolates were resistance to ampicillin (42.1%), chloramphenicol (36.8%), and co-trimoxazole (52.6%), respectively. The range of antimicrobial susceptibility to cephalosporins was from 52.6% for cephalothin to 57.8% for ceftriaxone, ceftazidime, cefixime and ceftizoxime. Multidrug resistances were ob served in 31.5% of H. influenzae type b isolates. Although we found high frequency of resistance to the first line drugs for H. influenzae type b in Iran, but the fre quency of this organism among children meningitis was lower than many Asian and European countries. PCR assay was more sensitive in detection of H. influenzae than culture method.

The aim of this study was to assess Leishmania infection in sand fly species from areas where leishmaniasis is endemic. This is important for prediction of the risk and expansion of the disease. In this cross-sectional study we used a PCR-based method for detection of Leishmania minicircle DNA within individual sand flies from Orzoieh, a new endemic leishmaniasis focus in southern Iran. We detected minicircle DNA in 6 of 92 (6.5%) Phlebotomus (Phlebotomus) papatasi collected indoor, while all of previous microscopic examination of sand flies specimens was negative for Leishmania promastigotes in the region. The species were identified as Leishmania (Leishmania) major by comparison of PCR products with a L. major positive control. All the Leishmania-positive sand flies were confirmed as P. (P.) papatasi by using a morphological key of Iranian sand flies. Since PCR method is relatively easy and can process a large number of samples, it will be a powerful tool for the rapid identification of Leishmania species as well as monitoring the infection rate in sand fly populations in areas of low endemicity of leishmaniasis.

The association between maternal smoking and poor pregnancy outcome, which is well established in medi cal literature, has also been corroborated by the results of this study conducted in a Turkish hospital. Our objective was to investi gate the effects of cigarette smoking during pregnancy on infant head circumference, height, weight, and body mass in dex (BMI). In this retrospective study, the data was collected from the Medical Live Birth Registry in a maternity hospital with the largest capacity of births in a city of northwest Turkey during 2002. We found that 16.4% (1040/6332) of mothers investigated had smoked during their pregnancy, with a mean of 5 ciga rettes per day. Head circumference, height, weight and BMI values of male infants whose mothers smoked were found to be less than those of infants whose mothers did not smoke (P> 0.05, for each one). Head circumference, height, weight and BMI values of female infants whose mothers smoked were less than those whose mothers did not smoke (P> 0.05, P< 0.01, P< 0.05 and P> 0.05, respectively). According to analysis of variance, infant head circumferences, heights and weights in all infants decreased as the rate of the mother’s smoking increased (P> 0.05, P< 0.001 and P> 0.05, respec tively). The results support that maternal smoking during pregnancy was associated with a linear reduction of height meas urement, and the infants appeared to be more susceptible to the growth retarding effects of cigarette smoking on height. Thus, if cessation-of-smoking programs are initiated before conception, many of the harmful effects of smoking on fe tal growth might be prevented.

Sputum smear examination is the basis of diagnosis of tuberculosis and quality control for the correct diagno sis of tuberculosis is necessary. This study was a method survey and performed with 930 smears with the aim to compare the confidence rate of sputum smear examination reported by one laboratory technician with the findings reported by two techni cians in a tuberculosis screening program. In this method survey study in Qaemshahr, smears collected from one laboratory were sent to another laboratory for re-examination and duplicate reading and the findings were subsequently compared. Cultures were used as a standard con trol test. Comparison showed that the rate of agreement between positive and negative findings of both laboratories was %73.8 and %99.3, respectively. First laboratory reading and its culture results were similar in 89% of cases. There was no sig nifi cant decrease in the frequency of false negative results of smears which were read twice as compared to those which had been read once only. The current method of screening patients suspected with tuberculosis, in which all sputum smears are read by a sin gle technician, is accepted as an accurate and reliable method for the diagnosis of tuberculosis.

In order to study the biology of Mylabris impressa stillata, which little is known about, a laboratory colony was established. In this descriptive study, the laboratory colony was collected from Toyserkan County in Hamedan Province, Iran. To feed the larval instars, a parallel colony of the grasshopper, Schistocerca gregaria was set-up. Meloid females lived for several months and laid egg masses with the intervals of about 2 weeks. The first instar larvae, named triungulin, were heav ily sclerotized, campodiform, prognathous, and highly mobile. They were fed with fresh eggs of Schistocerca gregaria and the pollen paste. This stage was followed by five FG instars which are weakly sclerotized and hypognathous. After a week of being fed, FG5 started digging the soil and subsequently was changed to a coarctate larva which characterized by dia pause. We succeeded to break such a diapause in laboratory by chilling at 5º C for four months. Thereafter, the larvae moulted to the next step which is called the Second Grub larvae. SG did not feed and was moulted to pupa in the same moist soil. New adults generally rested for three or four days following emergence, their feeding began at the adult age of a week and sexual behaviour normally appeared at a mean age of about 10 days. The complete life cycle of Mylabris impressa took about nine months. Laboratory rearing of blister beetles remains the best tool for ecological and chemical research as well as nup tial gift studies, but very labour intensive and time consuming with low yield.

In the current study, pattern of substance abuse among adolescence and early adulthood that have experienced one or more substances was assessed, and also parental support, religiosity, and locus of control were measured. This cross-sectional study was conducted in Hamadan City, Iran in 2006. All subjects were selected from Hama dan City (urban area), Iran based on snowball sampling method. Participants were males who used alcohol and illicit drugs in their life (n=398), completed a self-administered questionnaire. Approximately half of the participants were used to smoke, drink, take marijuana and/or use opium regularly, and one in ten had taken ecstasy or heroine in the last weeks. Tobacco and alcohols were most common substance as a gateway and consequently marijuana and opium were the next substances. Initiation age result for using substance was ages 13 to 18 years. More than 90% classified as group who suffering familial support, 60.8% as low level of religiosity, and 51.5% of partici pants was external locus of control. Our findings were similar to western countries pattern except that for opium. The high rate substances use by adoles cents and changes in pattern of use suggests that all drug use need to be taken into account when addressing adoles cents'' substance use. Moreover, research is needed to identify possible mechanisms underlying the association between binge drug uses in the vulnerable groups.

Brucellosis is a zoonotic disease and its symptoms and appearances are not exclusive in human and its tradi tional diagnosis is based on blood culture and serological methods. For more sensitive and specific detection, the PCR method is recommended. One hundred four blood samples were gathered from suspicious patients with brucellosis different ages form Ker manshah, Mazandaran, Khorassan and Hormozgan provinces, and were examined by Rose Bengal, anti globulin, culture and PCR methods. Seventy three samples were positive by PCR method, 15 samples were positive by cultured method and 84 sam ples were positive by serological methods. PCR method is sensitive and specific for diagnosis of Brucella from peripheral blood in suspected cases.

Obesity is associated with increased lipid peroxidation. It has also been suggested that risk of lipid peroxida tion increases with increasing body iron stores. The aim of this study was to examine the association of body iron status with the concentration of plasma malondialdehyde (P-MDA) as a marker of lipid peroxidation in obese and non-obese women. In a case control study we investigated iron status by plasma ferritin, iron and total iron binding capacity (TIBC) meas urements and lipid peroxidation by plasma malondialdehyde (MDA) levels measurements in 25 obese women and 25 non-obese women matched for age. Plasma ferritin levels were significantly higher in obese groups compared with control groups (P< 0.001). Plasma TIBC levels were not different in both groups and plasma iron levels were significantly higher in obese groups (P< 0.05). In obese groups, plasma MDA levels were significantly higher when compared with control groups (P< 0.001). There were posi tive correlation between body mass index and plasma MDA levels (r= 0.75, P< 0.0001). Plasma MDA levels were posi tively correlated with plasma iron levels (r= 0.26, P= 0.001) and plasma ferritin levels (r= 0.39, P< 0.0001) but not with TIBC levels. These findings suggest that obese menstruating women are at low risk of depleting iron stores and hence, increas ing body iron elevates the CHD risk by promoting the lipid peroxidation. Therefore, iron fortification programs might be undesirable for such subjects.

Otitis media with effusion (OME) is common in the children. It is proven that pathogenic bacteria as a causative agent of middle ear effusion, however the role of fungal infection in otitis media with effusion remains unclear. Therefore, this study was conducted to assess presence of fungi in OME. From January 2005 to September 2006, a number of 62 children with proven otitis media with effusion subjected to the case series study at Amiralmomenin Hospital in Rasht City, Iran. After myringotomy, middle ear effusion was collected. In 48 patients, both ears demonstrated effusion, whereas in 14 patients, only one ear had effusion. Standard mycological culture and polymerase chain reaction (PCR) assay were performed in 110 and 79 samples, respectively. The growth of fungi was observed in 9 samples (8.8%). The result of our PCR assay showed that 23 samples (29.1%) were positive for fungal DNA. Middle ear effusion from cases with OME contains fungi and it might play a role in the pathogens of OME. PCR assay is a better indicator in detection of fungus in middle ear effusion, compared with fungal culturing method. However, the estimation of its sensitivity and specificity in detection of fungal agents in these patients needs more molecular epidemiological studies.

In this study, erythromycin resistance isolates from the students with aged 12-15 yr old were studied and the mutations in the 23S rRNA were identified by sequencing. Throat samples of 327 students with 12-15 years old from 3 schools of Tehran were cultured on the selective Strep tococ cus pyogenes medium and 23 strains were primarily selected as S. pyogenes. All strains were susceptible to penicillin and bacitracin (0.04U). Minimum inhibitory of concentrations (MICs) for eryth romycin were determined in which 5 strains were found intermediate, 2 strains resistance and the remaining 16 strains susceptible to erythromycin. MIC for the erythromycin-resistance strains, BT3 and BT4, were 8.2 and 12.4 µg/ml, respec tively. PCR was performed for each six 23S rRNA operons and a fragment with 550 bp was sequenced. For two resis tance strains, BT3 and BT4 there were a mutation in position 2059 (A to G). Also another mutation in position 2529 (G to A) was detected in BT3. In addition to mutation at the position 2058 other point mutations in different positions of domain V involve in the resistance to macrolides.

Coronary artery bypass grafting surgery (CABG) and precutaneous transluminal coronary intervention (PCI) are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxi ety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving car diac rehabilitation programs. In this descriptive- analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxi ety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the pre sent study. PCI patients as compared to CABG patients experience higher anxiety (P= 0.02) and lower perceived social sup port (P= 0.02). Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01). It is necessary to be more considerate to psychological problems in the PCI patients.

Hepatitis A virus (HAV) is a single strand and non-enveloped RNA virus. It is usually transmitted by the fe cal-oral and the blood transfusion routes and causes the hepatitis A disease. Clinically, the hepatitis A is usually mild, par ticularly in children, in whom it is frequently subclinical. The disease is more serious and prolonged in adults. The objective of this study was to find the prevalence of HAV among blood donors in Tehran, Iran. Sera of 407 blood donors in Tehran Blood Transfusion Center who were negative for anti-HIV, HBs Ag and anti-HCV were tested for total anti-HAV antibody, anti-HAV IgM and HAV RNA. Total antibodies (IgG+IgM) and IgM were determined by ELISA using commercial kits. HAV RNA was detected by nested RT-PCR. The prevalence of total anti-HAV antibodies in blood donors were was 86%, and also the ratio 99% of blood do nors was negative for anti-HAV IgM and 1% was equivocal. HAV RNA was not found in any serum samples. The preva lence of total anti-HAV antibodies among blood donors was high; it means most of them were infected in childhood. In spite of, 14% of blood donors were negative for total anti-HAV antibodies; the prevalence of anti-HAV IgM and HAV RNA were very low. Carefully blood donor selection is performed in Iran.

Hepatitis A virus (HAV) is a single strand and non-enveloped RNA virus. It is usually transmitted by the fe cal-oral and the blood transfusion routes and causes the hepatitis A disease. Clinically, the hepatitis A is usually mild, par ticularly in children, in whom it is frequently subclinical. The disease is more serious and prolonged in adults. The objective of this study was to find the prevalence of HAV among blood donors in Tehran, Iran. Sera of 407 blood donors in Tehran Blood Transfusion Center who were negative for anti-HIV, HBs Ag and anti-HCV were tested for total anti-HAV antibody, anti-HAV IgM and HAV RNA. Total antibodies (IgG+IgM) and IgM were determined by ELISA using commercial kits. HAV RNA was detected by nested RT-PCR. The prevalence of total anti-HAV antibodies in blood donors were was 86%, and also the ratio 99% of blood do nors was negative for anti-HAV IgM and 1% was equivocal. HAV RNA was not found in any serum samples. The preva lence of total anti-HAV antibodies among blood donors was high; it means most of them were infected in childhood. In spite of, 14% of blood donors were negative for total anti-HAV antibodies; the prevalence of anti-HAV IgM and HAV RNA were very low. Carefully blood donor selection is performed in Iran.

Maternal hyperglycemia during early gestation is associated with an increased incidence of congenital anomalies. A case of mater nal diabetes syndrome is presented here with a rare constellation of congenital anomalies, i.e., bifurcated distal pha lanx of the thumb, patent ductus arteriosus and cleft lip.